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Definitions

• This invention relates to a pharmaceutical composition
• a pharmaceutical composition comprising a compound having angiotensin II antagonistic activity or a salt thereof in combination with at least one species selected from the group consisting of a compound having the activity of increasing insulin-sensitivity, a compound having the activity of improving postprandial hyperglycemia in diabetes mellitus, an indane derivative having the activity of inhibiting angiotensin converting enzyme, a pyridine derivative having the activity of inhibiting HMG-Co A reductase or salts of them, and to the use of the composition.
• Angiotensin II has a strong vasoconstrictive action, aldosterone-synthesizing action and cell-propagating action, which has been considered as one of the mediators of various circulatory diseases.
• An angiotensin II antagonistic drug suppressing the action of angiotensin, which antagonizes to this angiotensin II at angiotensin II receptor, is useful for the prophylaxis and therapy of circulatory diseases including hypertension, cardiac diseases (e.g. heart failure, myocardial infarction, etc.), cerebral apoplexy, nephritis, arteriosclerosis, etc.
• an angiotensin converting enzyme drug suppresses conversion of angiotensin I to angiotensin II, which is considered, like angiotensin II antagonistic drugs, as useful for the prophylaxis and therapy of circulatory diseases including hypertension, cardiac diseases (e.g. heart failure, myocardial infarction, etc.), cerebral apoplexy, nephritis, arteriosclerosis, etc.
• angiotensin converting enzyme is the same enzyme as kininase II which destructs kinin, and it has no substrate specificity, it has such an undesirable side effect as depositing inflammatory peptide including kinin and the substance P to cause occurrence of cough.
• HMG-Co A reductase 3-hydroxy-3-methylglutaryl coenzyme A reductase
• This invention is intended, by combination of a compound having angiotensin II antagonistic action or a salt thereof with a compound having action mechanism other than the above, to perform especially remarkable effects in angiotensin II-mediated diseases, especially hypertension, hyperlipemia, arteriosclerosis and so on, singly or complications of these diseases and to cover up various defects observed in administration of a medicine consisting of a single component.
• a compound having angiotensin antagonistic activity or a salt thereof, which is the essential component with at least one species selected from the group consisting of a compound having an insulin sensitivity increasing action, a compound having the activity of improving postprandial hyperglycoplasmia in diabetes mellitus, an indane derivative having the action of inhibiting angiotensin converting enzyme, a pyridine derivative having the action of HMG-Co A reductase or salts thereof, and, as a result, they have found that the co-use performs especially remarkable effects (e.g. in the treatment effect, safety, stability, dose, administration route, method of use, etc.) which were not observed in the administration of the respective compounds singly, and they have conducted further studies to accomplish the present invention.
• the present invention relates to
• the compound having the angiotensin II antagonistic activity or salts thereof include benzimidazol-7-carboxylic acid derivatives and salts thereof disclosed in, for example, JP-A [Japanese Patent Application Laid-open No.] H4(1992)-9373, EP-A-425921, JP-A H4(1992)-364171, EP-A-459136 and EP-A-520423, preferably compounds represented by the following formula (I) or salts thereof (preferably, pharmacologically acceptable salts).
• R 1 stands for H or an optionally substituted hydrocarbon residue
• R 2 stands for an optionally esterified carboxyl group
• R 3 stands for a group capable of forming anion or a group convertible thereto
• X shows that phenylene group and phenyl group are bonded directly or through a spacer having a chain length of 1 to 2 atoms
• n denotes 1 or 2
• the ring A is a benzene ring optionally having further substituents other than groups shown by R 2
• Y stands for a bond, -O-, -S(O)m- (wherein m denotes 0, 1 or 2) or -N(R 4 )- (wherein R 4 stands for H or an optionally substituted alkyl group).
• examples of the hydrocarbon residue shown by R 1 include alkyl, alkenyl, alkynyl, cycloalkyl, aryl and aralkyl groups. Among them, alkyl, alkenyl and cycloalkyl groups are preferable.
• the alkyl group shown by R 1 is a straight chain or branched lower alkyl group having 1 to about 8 carbon atoms, as exemplified by methyl, ethyl, propyl, isopropyl, butyl, isobutyl, sec-butyl, t-butyl, pentyl, i-pentyl, hexyl, heptyl and octyl.
• the alkenyl group shown by R 1 is a straight chain or branched lower alkenyl group having 2 to about 8 carbon atoms, as exemplified by vinyl, propenyl, 2-butenyl, 3-butenyl, isobutenyl and 2-octenyl.
• the alkynyl group shown by R 1 is a straight chain or branched lower alkynyl group having 2 to about 8 carbon atoms, as exemplified by ethynyl, 2-propynyl, 2-butynyl, 2-pentynyl and 2-octynyl.
• the cycloalkyl group shown by R 1 is a lower cycloalkyl group having 3 to about 6 carbon atoms, as exemplified by cyclopropyl, cyclobutyl, cyclopentyl and cyclohexyl.
• alkyl, alkenyl, alkynyl or cycloalkyl group may optionally be substituted with hydroxyl group, an optionally substituted amino group (e.g. amino, N-lower (C 1-4 )alkylamino, N,N-dilower (C 1-4 ) alkylamino, etc.), halogen, a lower (C 1-4 ) alkoxy group or a lower (C 1-4 ) alkylthio group.
• amino group e.g. amino, N-lower (C 1-4 )alkylamino, N,N-dilower (C 1-4 ) alkylamino, etc.
• halogen e.g. amino, N-lower (C 1-4 )alkylamino, N,N-dilower (C 1-4 ) alkylamino, etc.
• halogen e.g. amino, N-lower (C 1-4 )alkylamino, N,N-di
• the aralkyl group shown by R 1 is exemplified by a phenyl-lower (C 1-4 ) alkyl such as benzyl, phenethyl, etc. and the aryl group shown by R 1 is exemplified by phenyl, etc.
• aralkyl or aryl group may optionally have, on any position of its benzene ring, for example, halogen (e.g. F, Cl, Br, etc.), nitro, an optionally substituted amino group (e.g. amino, N-lower (C 1-4 ) alkylamino, N,N-dilower (C 1-4 ) alkylamino, etc.), lower (C 1-4 ) alkoxy (e.g. methoxy, ethoxy, etc.), lower (C 1-4 ) alkylthio (e.g. methylthio, ethylthio, etc.), lower (C 1-4 ) alkyl (e.g. methyl, ethyl, etc.), etc.
• halogen e.g. F, Cl, Br, etc.
• nitro an optionally substituted amino group
• alkyl optionally substituted alkyl, alkenyl or cycloalkyl groups [e.g. a lower (C 1-5 ) alkyl, lower (C 2-5 ) alkenyl or lower (C 3-6 ) cycloalkyl group optionally substituted with hydroxyl group, amino group, halogen or a lower (C 1-4 ) alkoxy group] are preferable.
• Y stands for a bond, -O-, -S(O)m- (wherein m denotes 0, 1 or 2) or -N(R 4 )- (wherein R 4 stands for H or an optionally lower alkyl group), preferably a bond, -O-, -S- or -N(R 4 )- [wherein R 4 stands for H or a lower (C 1-4 ) alkyl (e.g. methyl, ethyl, propyl, isopropyl, butyl, sec-butyl, t-butyl, etc.)].
• R 4 stands for H or a lower (C 1-4 ) alkyl (e.g. methyl, ethyl, propyl, isopropyl, butyl, sec-butyl, t-butyl, etc.)].
• the group shown by R 3 capable of forming anion (a group having a hydrogen atom capable of leaving as proton), or a group capable of changing thereto, is exemplified by 5- to 7-membered (preferably 5- to 6-membered) monocyclic optionally substituted heterocyclic ring residue which contain one or more of N, S and O (preferably N-containing heterocyclic ring residue having a hydrogen atom capable of leaving as proton) or groups capable of changing thereto in vivo .
• Such groups include the following:
• the chemical bond between the group shown by R 3 and the partner phenyl group may be a carbon-carbon bond as shown above, or a nitrogen-carbon bond via one of the several nitrogen atoms when the symbol g stands for -NH- in the above formulae.
• R 3 when R 3 is shown by , specific examples include:
• Other examples of R 3 bonded through nitrogen atom include:
• m denotes 0, 1 or 2;
• R 7 stands for H or an optionally substituted lower alkyl group (e.g. a lower (C 1-4 ) alkyl such as methyl, ethyl, propyl, isopropyl, butyl, sec-butyl and t-butyl).
• R 3 include 2,5-dihydro-5-oxo-1,2,4-oxadiazole ring residue, 2,5-dihydro-5-thioxo-1,2,4-oxadiazole ring residue or 2,5-dihydro-5-oxo-1,2,4-thiadiazole ring residue having -NH or -OH group as proton donor and carbonyl group, thiocarbonyl group or sulfinyl group as proton acceptor simultaneously.
• R 3 may form a condensed ring by connecting the substituents on the ring, it is preferably a 5- to 6-membered ring, more preferably a 5-membered heterocyclic residue.
• R 3 can be substituted at any of the ortho, meta and para position of the phenyl group, most preferably at the ortho position.
• heterocyclic residue (R 3 ) have the following tautomeric isomers.
• R 3 may be a carboxyl group, tetrazolyl group, trifluoromethanesulfonamide group (-NHSO 2 CF 3 ), phosphoric acid group, sulfonic acid group, cyano group or lower (C 1-4 ) alkoxycarbonyl group; these groups each may be protected with an optionally substituted lower alkyl group or acyl group, and, any group capable of forming an anion biologically or physiologically (e.g. through biological reactions such as oxidation, reduction or hydrolysis caused by enzymes in the body) or chemically, or a group capable of changing thereto is acceptable.
• R 3 can be substituted at any of ortho-, meta- and para-positions, preferably at the ortho-position.
• X shows the linkage of phenylene group and phenyl group adjacent to each other directly or through a spacer having a chain length of 1 to 2 atoms (preferably direct linkage).
• n denotes an integer of 1 or 2 (preferably 1).
• the optionally esterified carboxyl group shown by R 2 is exemplified by groups represented by the formula -CO-D [wherein D stands for a hydroxyl group or an optionally substituted alkoxy group ⁇ e.g. (i) a lower (C 1-6 ) alkoxyl group whose alkyl moiety is optionally substituted with (1) a hydroxyl group, (2) an optionally substituted amino (e.g.
• R 6 stands for (1) H, (2) a lower (C 1-6 ) straight chain or branched alkyl group (e.g. methyl, ethyl, n-propyl, isopropyl, n-butyl, isobutyl, t-butyl, n-pentyl, isopentyl, neopentyl, etc.), (3) a lower (C 2-6 ) straight chain or branched alkenyl group (e.g.
• R 5 stands for (1) a lower (C 1-6 ) straight chain or branched alkyl group (e.g.
• cyclopentyl cyclohexyl, cycloheptyl, etc.
• a lower (C 1-3 ) alkyl group substituted with (C 3-8 ) cycloalkyl group e.g. cyclopentyl, cyclohexyl, cycloheptyl, etc.
• an optionally substituted aryl group such as phenyl and naphthyl optionally substituted with halogen, nitro or a lower (C 1-4 ) alkyl (e.g.
• alkenyl moiety such as vinyl, propenyl, allyl and isopropenyl
• aryl group such as phenyl and naphthyl optionally substituted with halogen, nitro or a lower (C 1-4 ) alkyl (e.g. phenyl, p-tolyl, naphthyl, etc.)
• a lower (C 1-6 ) straight chain or branched alkoxy group e.g.
• cycloalkyl e.g. cyclopentyl, cyclohexyl, cycloheptyl, etc.
• aryl group such as phenyl and naphthyl optionally substituted with halogen, nitro or lower (C 1-4 ) alkyl (e.g. benzyloxy,
• alkoxy moiety such as methoxy, ethoxy, n-propoxy, isopropoxy, etc.
• a lower (C 2-3 ) lower alkenyloxy group substituted with a C 3-8 cycloalkyl (e.g. cyclopentyl, cyclohexyl, cycloheptyl, etc.) or with an optionally substituted aryl group such as phenyl and naphthyl optionally substituted with halogen, nitro or lower (C 1-4 ) alkyl (e.g. cinnamyloxy, etc.
• R 2 may be a group actually or potentially capable of forming anion [e.g. tetrazolyl group, trifluoromethanesulfonamide group, phosphoric acid group or sulfonic acid group optionally protected with an optionally substituted alkyl (e.g. lower (C 1-4 ) alkyl, etc.) or acyl (e.g. lower (C 2-5 ) alkanoyl, optionally substituted benzoyl, etc.)].
• anion e.g. tetrazolyl group, trifluoromethanesulfonamide group, phosphoric acid group or sulfonic acid group optionally protected with an optionally substituted alkyl (e.g. lower (C 1-4 ) alkyl, etc.) or acyl (e.g. lower (C 2-5 ) alkanoyl, optionally substituted benzoyl, etc.)].
• substituent R 2 examples include -COOH and its salts, -COOMe, -COOEt, -COOtBu, -COOPr, pivaloyloxymethoxycarbonyl, 1-(cyclohexyloxycarbonyloxy)ethoxycarbonyl, (5-methyl-2-oxo-1,3-dioxolen-4-yl)methoxycarbonyl, acetoxymethoxycarbonyl, propionyloxymethoxycarbonyl, n-butyryloxymethoxycarbonyl, isobutyryloxymethoxycarbonyl, (1-ethoxycarbonyloxyethoxy)carbonyl, (1-acetoxyethoxy)carbonyl, (1-isobutyryloxyethoxy)carbonyl, cyclohexylcarbonyloxymethoxycarbonyl, benzoyloxymethoxycarbonyl, cinnamyloxycarbonyl and cyclopentylcarbonyloxymeth
• R 2 may be any of the groups actually or potentially capable of forming anion (e.g. COO - or its derivatives) under biologic or physiologic conditions (e.g. oxidation or reduction induced by enzyme present in the living body, or in vivo reaction such as hydrolysis) or chemically.
• R 2 may be carboxyl group or its prodrug.
• R 2 may be a group capable of being biologically or chemically transformed, for example, in vivo to anion.
• preferable ones include carboxyl, esterified carboxyl (e.g. methyl ester, ethyl ester or an ester formed by binding of a group shown by the formula -O-CH(R 6 )-OCOR 5 to carbonyl) and optionally protected tetrazolyl, carboaldehyde and hydroxymethyl.
• esterified carboxyl e.g. methyl ester, ethyl ester or an ester formed by binding of a group shown by the formula -O-CH(R 6 )-OCOR 5 to carbonyl
• optionally protected tetrazolyl optionally protected tetrazolyl, carboaldehyde and hydroxymethyl.
• ring A may have, in addition to the group shown by R 2 , further substituents as exemplified by halogen (e.g. F, Cl, Br, etc.), cyano, nitro, lower (C 1-4 ) alkyl, lower (C 1-4 ) alkoxy, an optionally substituted amino group ⁇ e.g. amino, N-lower (C 1-4 ) alkylamino (e.g. methylamino, etc.), N,N-di-lower (C 1-4 ) alkylamino (e.g. dimethylamino, etc.), N-arylamino (e.g. phenylamino, etc.), alicyclic amino (e.g.
• D' stands for hydroxyl group or a lower (C 1-4 ) alkoxy group whose alkyl moiety may optionally be substituted with hydroxyl group, lower (C 1-4 ) alkoxy, lower (C 2-6 ) alkanoyloxy (e.g. acetoxy, pivaloyloxy, etc.) or lower (C 1-6 ) alkoxycarbonyloxy (e.g. chain-like alkoxycarbonyloxy such as methoxycarbonyloxy, ethoxycarbonyloxy, etc.
• ring A stands for a benzene ring optionally having further substituents besides groups shown by R 2 ;
• R 1 stands for H or an optionally substituted lower (C 1- 6 ) alkyl (preferably lower alkyl (C 1-4 ) alkyl);
• Y stands for -O-, -S- or -N(H)-;
• R 2 is a group represented by the formula -CO-D" [wherein D" stands for hydroxyl group, or a lower (C 1-4 ) alkoxy whose alkyl moiety is optionally substituted with hydroxyl group, amino, halogen, a lower (C 2-6 ) alkanoyloxy (e.g.
• acetyloxy, pivaloyloxy, etc. a lower (C 4-7 ) cycloalkanoyloxy, (lower (C 1-6 )alkoxy)carbonyloxy (e.g. methoxycarbonyloxy, ethoxycarbonyloxy, etc.), (lower (C 3-7 )cycloalkoxy)carbonyloxy (e.g.
• n denotes 1 or 2 (preferably 1)].
• halogen e.g. F, Cl, Br, etc.
• lower (C 1-4 ) alkyl lower (C 1-4 ) alkoxy, nitro
• a group represented by the formula -CO-D' [wherein D' stands for a hydroxyl group or lower (C 1-4 ) alkoxy whose alkyl moiety may optionally be substituted with hydroxyl group, lower (C 1-4 ) alkoxy, lower (C 2-6 ) alkanoyloxy (e.g. acetoxy, pivaloyloxy, etc.) or lower (C 1-6 ) alkoxycarbonyloxy (e.g.
• a benzene ring which has no substituent other than the group represented by the formula R 2 , is more preferable.
• a salt with an inorganic base an organic base, an iorganic acid, an organic acid, or a basic or acidic amino acid.
• a salt with an inorganic base include alkali metal salts such as sodium salts, potassium salts, and so on; alkaline earth metal salts such as calcium salts, magnesium salts, and so on; as well as aluminum salts, ammonium salts, etc.
• a salt with an organic base include salts with trimethylamine, triethylamine, pyridine, picoline, ethanolamine, diethanolamine, triethanolamine, dicyclohexylamine, N,N'-dibenzylethylenediamine, N-methylmorpholine, etc.
• a salt with an inorganic acid include salts with hydrochloric acid, hydrobromic acid, nitric acid, sulfuric acid, phosphoric acid, etc.
• the salt with an organic acid include salts with formic acid, acetic acid, trifluoroacetic acid, fumaric acid, oxalic acid, tartaric acid, maleic acid, citric acid, succinic acid, malic acid, methanesulfonic acid, benzenesulfonic acid, p-toluenesulfonic acid, etc.
• Preferable examples of a salt with a basic amino acid include salts with arginine, lysine, ornithine, etc.
• Preferable examples of a salt with an acidic amino acid include salts with aspartic acid, glutamic acid, etc.
• Preferable compounds to be employed as the active ingredient of the present invention include those described in the Examples of JP-A H4(1992)-364171/1992, EP-A-459136 and EP-A-520423. Among them, ( ⁇ )-1-(cyclohexyloxycarbonyloxy)ethyl 2-ethoxy-1-[[2'-(1H-tetrazol-5-yl)biphenyl-4-yl]methyl]-lH-benzimidazole-7-carboxylate, 2-ethoxy-1-[[2'-(1H-tetrazol-5-yl)biphenyl-4-yl]methyl]-1H-benzimidazole-7-carboxylic acid, 2-ethoxy-1-[[2'-(2,5-dihydro-5-oxo-1,2,4-oxadiazol-3-yl)biphenyl-4-yl]methyl]-1H-benzimidazole-7-carboxylic acid or pharmaceutically acceptable salts thereof
• the compounds represented by the general formula (I) are disclosed in, for example, JP-A H4(1992)-9373, EP-A-425921, JP-A H4(1992)-364171, EP-A-459136 and EP-A-520423, which can be produced by the methods disclosed in these official publications or methods analogous thereto.
• the compound having the activity of increasing insulin-sensitivity to be used for the present invention or salts thereof mention is made of a compound having the activity of normalizing the function of the receptor whose insulin-activity is damaged, namely a compound having the activity of releasing the insulin-resistance, or salts thereof.
• a compound having the activity of normalizing the function of the receptor whose insulin-activity is damaged namely a compound having the activity of releasing the insulin-resistance, or salts thereof.
• Specific examples of such compounds as above include 2,4-thiazolidinedione, 2,4-oxazolidinedione derivatives or salts thereof described in EP-A-193256, Japan Patent Application No.
• H7(1995)-284106 EP-A-710659
• JP-A S60(1985)-51189 or known compounds having the activity of increasing insulin-sensitivity, for example, 5-[[3,4-dihydro-2-(phenylmethyl)-2H-1-benzopyran-6-yl]methyl]-2,4-thiazolidinedione (generic name: englitazone); 5-[[4-[3-(5-methyl-2-phenyl-4-oxazolyl)-1-oxopropyl]phenyl]methyl]-2,4-thiazolidinedione (generic name: darglitazone; CP-86325); 5-[2-(5-methyl-2-phenyl-4-oxazolylmethyl)benzofuran-5-ylmethyl]-2,4-oxazolidinedione (CP-92768); 5-(2-naphthalenylsulfonyl)-2,4-thiazolidinedione (AY-31637); 4-[(2-
• Preferable compounds include those described as Working Examples in EP-A-193256, Japan Patent Application No. H7(1995)-284106 (EP-A-710659) or JP-A S60(1985)-51189.
• 2,4-thiazolidinedione or 2,4-oxazolidinedione derivatives such as 5-[4-[2-(3-ethyl-2-pyridyl)ethoxy]benzyl]-2,4-thiazolidinedione, 5-[4-[2-(5-ethyl-2-pyridyl)ethoxy]benzyl]-2,4-thiazolidinedione, 5-[4-[2-(5-ethyl-2-pyridyl)ethoxy]benzyl]-2,4-thiazolidinedione, 5-[4-[2-(5-ethyl-2-pyridyl)ethoxy]benzyl]-2,4-thiazolidinedione, 5-[4-[2-(5-
• salts of a compound having the activity of increasing (enhancing) insulin-sensitivity include pharmaceutically acceptable salts, which are specifically exemplified by substantially the same ones as pharmaceutically acceptable salts of the above-mentioned compounds having the angiotensin II antagonistic activity.
• the compound having the activity of improving postprandial hyperglycemia in diabetes mellitus or salts thereof to be used in the present invention mention is made of a compound having the activity of inhibiting ⁇ -glucosidase and having the activity of inhibiting a digestive enzyme such as amilase, maltase, ⁇ -dextrinase, sucrase and so on to delay the digestion of starch or sucrose, or salts thereof.
• a digestive enzyme such as amilase, maltase, ⁇ -dextrinase, sucrase and so on to delay the digestion of starch or sucrose, or salts thereof.
• valiolamine derivatives or salts thereof described in EP-A-56194, etc. acarbose or salts thereof described in USP 4062950, etc.
• salts of a compound having the activity of improving postprandial hyperglycemia in diabetes mellitus include pharmaceutically acceptable salts, which are specifically exemplified by substantially the same ones as pharmaceutically acceptable salts of the above-mentioned compounds having the angiotensin II antagonistic activity.
• indane derivatives having the activity of inhibiting angiotensin converting enzyme or salts thereof to be used in the present invention mention is made of indane derivatives or salts thereof having the antihypertensive activity by inhibiting angiotensin converting enzyme which converts angiotensin I to angiotensin II.
• preferable compounds mention is made of those described as Working Examples in JP-A S57(1982)-179141 or EP-A-51391.
• N-[N-[(S)-1-ethoxycarbonyl-3-phenylpropyl]-L-alanyl]-N-(indan-2-yl)glycine or salts thereof are preferable, and especially, N-[N-[(S)-1-ethoxycarbonyl-3-phenylpropyl]-L-alanyl]-N-(indan-2-yl)glycine hydrochloride is preferable.
• salts of indane derivatives having the activity of inhibiting angiotensin converting enzyme mention is made of pharmaceutically acceptable salts. As specific examples of them, mention is made of those which are substantially the same as pharmaceutically acceptable salts of the above-mentioned compound having the angiotensin II antagonistic activity.
• a compound having the angiotensin II antagonistic activity or a salt thereof is used in combination with an indane derivative having the activity of inhibiting angiotensin converting enzyme or a salt thereof.
• indane derivative having the activity of inhibiting angiotensin converting enzyme e.g., a compound having the angiotensin II antagonistic activity or a salt thereof.
• indane derivative having the activity of inhibiting angiotensin converting enzyme e.g.
• captopril enalapril, alacepril, ramipril, lisinopril imidapril, etc.
• any other antihypertensive agent such as ⁇ -blocker, ⁇ -blocker, a diuretic or a calcium antagonist may optionally be used in combination with an angiotensin II antagonist.
• pyridine derivative having the activity of inhibiting HMG-Co A reductase or a salt thereof to be used in the present invention mention is made of a pyridine derivative having the activity of inhibiting HMG-Co A reductase, which is a rate-limiting enzyme of cholesterol synthesis, or a salt thereof.
• JP-A H1(1989)-216974 EP-A-325130, JP-A H4(1992)-308573, USP 5177080, JP-B [Japanese Patent Examined Publication No.] H6(1994)-41448, EP-A-307342, JP-A H1(1989)-121266 and EP-A-306929.
• pyridine derivatives described as Working Examples in these official publications are more preferable, especially preferable one being (+)-3R,5S-erythro-(E)-7-[4-(4-fluorophenyl)-2,6-diisopropyl-5-methoxymethylpyridin-3-yl]-3,5-dihydroxyhept-6-enoic acid or salts thereof and most preferable one being_ (+)-3R,5S-erythro-(E)-7-[4-(4-fluorophenyl)-2,6-diisopropyl-5-methoxymethylpyridin-3-yl]-3,5-dihydroxyhept-6-enoate sodium.
• salts of a pyridine derivative having the activity of inhibiting HMG-Co A reductase mention is made of pharmaceutically acceptable salts, which are specifically exemplified by substantially the same ones as pharmaceutically acceptable salts of the above-mentioned angiotensin II antagonistic compounds.
• an angiotensin II antagonistic compound or a salt thereof is used in combination with a pyridine derivative having the activity of inhibiting HMG-Co A reductase or a salt thereof.
• a pyridine derivative having the activity of inhibiting HMG-Co A reductase or a salt thereof in place of the above-mentioned pyridine derivatives having the activity of inhibiting HMG-Co A reductase, any other agent of inhibiting HMG-Co A reductase (e.g. pravastatin, simvastatin, lovastatin or fluvastatin may optionally be employed.
• any other antihyperlipemic drug including an agent of inhibiting squalene synthesis and a fibrate compound having the activity of lowering triglyceride (e.g. bezafibrate) may optionally be used in combination with an angiotensin II antagonistic drug.
• a compound having the angiotensin II antagonistic activity or a salt thereof is employed in combination with at least one species of a compound having the activity of increasing insulin-sensitivity, a compound having the activity of improving postprandial hyperglycemia in diabetes mellitus, an indane derivative having the activity of inhibiting angiotensin converting enzyme, a pyridine derivative having the activity of inhibiting HMG-Co A reductase or salts thereof.
• a combination of one or more species of a compound having the activity of increasing insulin-sensitivity, a compound having the activity of improving postprandial hyperglycemia in diabetes mellitus, an indane derivative having the activity of inhibiting angiotensin converting enzyme, a pyridine derivative having the activity of inhibiting HMG-Co A reductase or salts of them may optionally be employed.
• any other drugs e.g. an antihypertensive drug, an antihyperlipemic drug, etc.
• any other drugs e.g. an antihypertensive drug, an antihyperlipemic drug, etc.
• these drugs can be formulated by mixing individually or simultaneously with pharmaceutically acceptable carriers, excipients, binders, diluents or the like, which can be administered orally or non-orally.
• kits for administering the individually formulated effective components in the form of their mixture prepared by using, for example, a diluent when administered e.g. a kit for injection which comprises two or more ampoules each comprising a powdery component and a diluent for mixing and dissolving two or more components when administered, etc.
• a kit for administering the individually formulated agents simultaneously or with time intervals to the one and same subject e.g.
• kits for tablets to be administered simultaneously or with time intervals characterized by having two or more tablets each comprising an agent and said tablets being put in one or separate bags and, if necessary, a column to describe time to be administered each agent, etc. are also included by the pharmaceutical composition of the present invention.
• composition of the present invention are as follows:
• a combination of a compound having the angiotensin II antagonistic activity or a salt thereof with at least one species of a compound having the activity of increasing insulin-sensitivity, a compound having the activity of improving postprandial hyperglycemia in diabetes mellitus or salts of them is preferably used.
• the pharmaceutical composition of this invention is used as a prophylactic or therapeutic agent of, for example, angiotensin II-mediated diseases of animals, especially mammals (e.g. man, dog, rabbit, rat, mouse, etc.), as exemplified by circulatory diseases including hypertension, cardiac insufficiency, cerebral apoplexy, ischemic peripheral circulation disturbances, myocardial ischemia, venous insufficiency, progressive cardiac insufficiency after myocardial infarction, diabetic nephropathy, nephritis, glomerulonephritis, arteriosclerosis, angiohypertrophy, vascular hypertrophy or obstruction after percutaneous transluminal coronary angioplasty, vascular reobstruction after bypass surgery, hyperaldosteronism, glomerulosclerosis, renal insufficiency, glaucoma, occular hypertension, hyperlipemia, myocardial infarction, angina pectoris, aneurysm, coronary arterio
• the pharmaceutical composition of this invention is preferably used as a prophylactic or therapeutic agent for, especially, circulatory diseases including diseases of central nervous system caused by circulatory disturbances.
• circulatory diseases including diseases of central nervous system caused by circulatory disturbances.
• use of the pharmaceutical composition of this invention is preferable, especially, use of it for the prophylaxis or therapy of artereiosclerosis is preferable.
• the pharmaceutical composition of this invention can be used.
• the pharmaceutical composition of this invention performs remarkable effects for the prophylaxis or therapy of diseases accompanied with diabetic, obesitic, hyperlipemic or essential hypertension. It is preferably used, especially, for the prophylaxis or therapy of arteriosclerosis accompanied with hypertension.
• the pharmaceutical composition of this invention can be administered orally or non-orally in the form of, for example, granules, powdery preparations, dust preparations, tablets, capsules, syrup, emulsions, suppositories (e.g. rectal suppositories and vaginal suppositories), injections (e.g. subcutaneous, intravenous, intramuscular or intraperitoneal injections), instillation, medicines for external application (e.g. preparations to be administered through nasal route, transdermally administrable preparations and ointments), emulsions, elixir, suspensions and solutions.
• injections e.g. subcutaneous, intravenous, intramuscular or intraperitoneal injections
• injections e.g. subcutaneous, intravenous, intramuscular or intraperitoneal injections
• instillation medicines for external application
• medicines for external application e.g. preparations to be administered through nasal route, transdermally administrable preparations and oin
• sterile injectable aqueous suspensions or oil suspensions can be prepared by known procedures in the relevant fields, using a suitable dispersant or wetting agent and suspending agent.
• the sterile injections may be in the state of, for example, a solution or a suspension, which is prepared with a non-toxic diluent administrable non-orally, e.g. an aqueous solution, or with a solvent employable for sterile injection.
• a non-toxic diluent administrable non-orally e.g. an aqueous solution, or with a solvent employable for sterile injection.
• examples of usable vehicles or acceptable solvents include water, Ringer's solution and an isotonic aqueous saline solution.
• a sterile non-volatile oil can usually be employed as solvent or suspending agent.
• Any non-volatile oil and a fatty acid can be used for this purpose, which include natural or synthetic or semi-synthetic fatty oil or fatty acid, and natural or synthetic or semi-synthetic mono- or di- or triglycerides.
• additives including a preservative, an isotonizer, a solubilizer, a stabilizer and a pain-soothing agent may adequately be employed.
• Rectal suppositories can be prepared by mixing the drug with a suitable non-irritable vehicle, for example, cocoa butter and polyethylene glycols, which are in the solid state at ordinary temperatures, but, in the liquid state at temperatures in intestinal tubes and melt in rectum to release the drug.
• a suitable non-irritable vehicle for example, cocoa butter and polyethylene glycols, which are in the solid state at ordinary temperatures, but, in the liquid state at temperatures in intestinal tubes and melt in rectum to release the drug.
• the active components can be mixed with at least one additive, for example, sucrose, lactose, cellulose sugar, mannitol, maltitol, dextran, starch, agar, alginates, chitins, chitosans, pectins, tragacanth gum, gum arabic, gelatins, collagens, casein, albumin, synthetic or semi-synthetic polymers or glycerides.
• formulations can contain, as in conventional cases, further additives, for example, an inactive diluent, a lubricant such as magnesium stearate, a preservative such as parabens and sorbic acid, an antioxidant such as ascorbic acid, ⁇ -tocopherol or cysteine, an excipient, a disintegrator, a binder, a thickening agent, a buffer, a sweetener, a flavoring agent, a perfuming agent and a coating agent. Tablets and pills can further be prepared with enteric coating.
• liquid preparations for oral administration include pharmaceutically acceptable emulsions, syrups, elixirs, suspensions and solutions, which may contain an inactive diluent, for example, water, which is conventionally employed in the relevant field.
• a formulation used for the pharmaceutical composition of this invention preferably comprises, as an effective component, about 0.6 to 39 weight % (more preferably about 0.7 to 27 weight %) of a compound having angiotensin II antagonistic activity or a salt thereof, about 0.06 to 35 weight % (more preferably about 0.6 to 23 weight %) of a compound having the activity of increasing insulin-sensitivity or a salt thereof,
• This formulation may be prepared by formulating two or more components individually or simultaneously.
• the pharmaceutical composition of this invention is less toxic, which is safely used for animals, especially mammals (e.g. man, dog, rabbit, rat, mouse, etc.) and can be used advantageously for prophylaxis or therapy of angiotensin II-mediated diseases.
• the dose of the pharmaceutical composition of this invention is determined in accordance with the dose of individual drugs, and can be selected dependent on the age, body weight, symptom, dose interval, administration routes, type of the formulation, and combination of drugs.
• the dose to be administered to a specific patient is dependent on the age, body weight, general health conditions, sex, diet, dose interval, administration routes, excretion rate, combination of drugs and conditions of the diseases then treated, while taking the minimal recommendable clinical dose or these and other necessary factors into consideration.
• Typical daily doses of the compositions having various combinations of an angiotensin II antagonistic compound or a salt thereof with at least one species of a compound having the activity of increasing insulin-sensitivity, a compound having the activity of improving postprandial hyperglycemia in diabetes mellitus, an indane derivative having the activity of inhibiting angiotensin converting enzyme, a pyridine derivative having the activity of inhibiting HMG-Co A reductase and salts thereof are within the range of from about 1/50 of the minimal recommendable clinical dose to maximal recommendable dose (preferably minimum recommendable dose, more preferably about 1/2 of minimum recommendable dose) in the case of practical administration of these compounds individually.
• ( ⁇ )-1-(cyclohexyloxycarbonyloxy)ethyl 2-ethoxy-[[2'-(1H-tetrazol-5-yl)biphenyl-4-yl]methyl]-1H-benzimidazole-7-carboxylate in a dose ranging from about 1 to 50 mg/patient/day (preferably from about 1 to 35 mg/patient/day) can be effectively combined with, for example, 5-[4-[2-(5-ethyl-2-pyridyl)ethoxy]benzyl]-2,4-thiazolidindione in a dose ranging from about 0.1 to 30 mg/patient/day (preferably from about 2 to 30 mg/patient/day) or N-(1,3-dihydroxy-2-propyl)valiolamine in a dose ranging from about 0.1 to 2 mg/patient/day.
• the unit dose is administered once or twice daily (preferably once).
• the pharmaceutical composition (especially the prophylactic or therapeutic agents of angiotensin II-mediated diseases, preferably therapeutic agent for arteriosclerosis of human adult) referred to in this invention, formulated by combination of a compound having the angiotensin II antagonistic activity or a salt thereof with at least one species of a compound having the activity of increasing insulin-sensitivity, a compound having the activity of improving postprandial hyperglycemia in diabetes mellitus, an indane derivative having the activity of inhibiting angiotensin converting enzyme, a pyridine derivative having the activity of inhibiting HMG-Co A reductase or salts thereof can be prepared by, for example, the following prescriptions. 1.
• composition of this invention formulated by combination of an angiotensin II antagonistic compound or a salt thereof with at least one species of a compound having the activity of increasing insulin-sensitivity, a compound having the activity of improving postprandial hyperglycemia in diabetes mellitus, an indane derivative having the activity of inhibiting angiotensin converting enzyme, a pyridine derivative having the activity of inhibiting HMG-Co A reductase or salts thereof serves to decrease remarkably the dosages of the individual effective components, and, as a result, suppresses undesirable side effects observed in the case of administering the respective compounds singly, and can be advantageously used as a prophylactic or therapeutic agent of angiotensin II-mediated diseases, especially arteriosclerosis or arteriosclerosis having hypertension as a complication.

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